Remote Medicaid Program Integrity Auditor (Data Analytics)

ForHealth Consulting at UMass Chan Medical School; Westborough (MA); Hybrid; USD 75,000 - 95,000; Full time

Job summary

ForHealth Consulting at UMass Chan Medical School is looking for a Fraud, Waste, and Abuse Auditor to identify and prevent fraud in Medicaid programs. This position involves conducting audits and investigations to ensure compliance with federal and state regulations. The role requires strong analytical and problem-solving skills, as well as the ability to work both independently and collaboratively.

The auditor will work remotely with onsite requirements 1-2 times monthly. Preferred qualifications include certifications like CPC or CPMA.

Qualifications

• 4-6 years of experience in the healthcare industry.
• At least 2 years in healthcare claim audits or data mining.
• Ability to analyze fraud-related trends and compliance.

Responsibilities

• Conduct desk and onsite audits to ensure compliance.
• Prepare detailed audit documentation and case files.
• Communicate with providers about compliance issues.

Skills

Analytical skills

Problem-solving skills

Customer service skills

Microsoft Office proficiency

Knowledge of CPT, HCPCS, and ICD-10 coding

Education

Bachelor's degree in business or healthcare administration

Job description

ForHealth Consulting at UMass Chan Medical School is looking for a Fraud, Waste, and Abuse Auditor to identify and prevent fraud in Medicaid programs. This position involves conducting audits and investigations to ensure compliance with federal and state regulations. The role requires strong analytical and problem-solving skills, as well as the ability to work both independently and collaboratively.

The auditor will work remotely with onsite requirements 1-2 times monthly. Preferred qualifications include certifications like CPC or CPMA.